1. Hospital Rewards Program: Data Reporting and Scoring
J. Dennis Bush
February 6, 2006

2. Leapfrog Hospital Rewards Program Data & Reporting Requirements
Objectives
Minimize additional reporting burden for hospitals
Rely on existing reporting systems, i.e., LFG hospital survey, JCAHO Core Measures
Parallel formats and processes already in place for any new data, e.g., data formats, severity adjustment processes
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

3. Leapfrog Hospital Rewards Program Data Requirements
Leapfrog Hospital Quality and Safety Survey
JCAHO Core Measures
Leapfrog Resource-Based Efficiency Measures 1 2 3
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

4. Data Reporting: Process Flow1
Leapfrog Patient Safety Survey
Program Licensees
Leapfrog
Survey Results
Clinical Area-specific Scores:
Quality
Resource-Based Efficiency
JCAHO Core Measures Data
Aggregation and Scoring 2
Hospital
Leapfrog
JCAHO Quality-only Vendor* 3
Full-Service Data Vendor
New
Data Licensees
LFG Efficiency Measures
Hospital Feedback via Vendors
* Hospitals may split data submission:
- quality data through existing “quality-only” JCAHO CMV
- efficiency data through Leapfrog-approved full-service vendor
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

5. Leapfrog Hospital Rewards Program Data Requirements
Leapfrog Hospital Quality and Safety Survey
Required for LHRP participation in ANY clinical area
Current survey, including affirmations
Latest (new cycle) survey as of May 31 for Jul 1 results
Latest survey as of Nov 30 for Jan 1 results
LHRP participating hospitals also complete “authorization & release” at on-line survey
Partial completion: no points earned for that component Example: process compliance not measured 1
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

6. Leapfrog Hospital Rewards Program Data Requirements
JCAHO Core Measures
Objective: no additional reporting burden
Core Measures must be reported for clinical area(s)
Copy of JCAHO data submission to LFG
add LFG hospital identifier
split HCO into component hospitals (<1%)
extraneous data ignored on submission, e.g., heart failure, unused measures
Timing
quarterly
15-30 day lag after JCAHO deadlines 2
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

7. Leapfrog Hospital Rewards Program Data Requirements
Leapfrog Resource-Based Efficiency Measures
By clinical area for which hospital participates in LHRP
Actual length of stay (LOS), routine and special*
Severity-adjusted expected LOS, routine and special**
# cases with readmit following discharge, within 14 days, same hospital, any condition at readmit 3
* Total length of stay for Deliveries
** See details about risk adjustment models at
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

8. Core Measure Vendors Play Critical Role
All hospitals must work through Leapfrog-approved “full-service” Core Measure Vendor
Register hospitals
Hospital authorization for data release
Participation options:
Time periods
Clinical areas
Masked/identified election
Assist hospitals with added efficiency measures
Pay hospital participation fees to Leapfrog
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

9. Core Measure Vendors Play Critical Role (cont’d)
Submit JCAHO and LFG efficiency data to national aggregator; decertify or replace bad data
Track data confirmations and data/program status of hospitals
Re-distribute hospital-specific results from Leapfrog
Vendor-only access to secure Web portal for hospital registration, data submission, status, and hospital-specific results
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

10. Vendor Qualifications
Operating as approved JCAHO Core Measures vendor
Commit to support LFG efficiency measures
Successfully submit test data to national aggregator
Contract with Leapfrog re: roles and responsibilities
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

11. Leapfrog Hospital Rewards Program Scoring
Weights
Scoring component measures
Composite score
Rankings on each axis
Quality
Resource-Based Efficiency rankings
Performance groups (4)
. . . by clinical area for participating hospitals
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

12. Leapfrog Hospital Rewards Program Quality Weighting
% Weight is assigned to each measure
Represents maximum points available for a measure
Add to 100%; possible composite score 0 – 100%
Basis1:
46% for mortality-related measures
29% for morbidity-related measures
25% for complication-related measures
Allocated evenly for measures within category, unless evidence of odds-ratio differences
See Weighting details in addenda and at
1 Pauly, M.V., Brailer, D.J., Kroch, E., and O. Even-Shoshan. "Measuring Hospital Outcomes from a Buyer's Perspective." American Journal of Medical Quality. Vol. 11(8): , Fall 1996.
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

13. Scoring Example: Pneumonia
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

14. Leapfrog Hospital Rewards Program Scoring Component Measures – Efficiency
Derive relative severity index from expected LOS
Standardize actual LOS for severity differences
Adjust total standardized LOS for readmissions = std LOS * (1 + readmit rate)
Score = # standard deviations better/ (worse) than all-group average adjusted LOS
. . . by clinical area
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

15. Scoring Example: Overall – Deliveries
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

16. Leapfrog Hospital Rewards Program Ranking Overall Quality and Efficiency Scores
Four tiers along each axis
1: Best quartile
2: Not significantly below best quartile (p > .10)
3: Significantly below best quartile (p < .10)
4: Significantly below best quartile (p < .05)
Cohorts – performance on both axes
Top cohort = 1st tier (best quartile) on both axes
Bottom cohort = 4th tier on either axis
. . . by clinical area
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

17. Hospitals Arrayed in Four Groups Example: Pneumonia
Cohort 1
Cohort 2
Average
Cohort 3
Cohort 4
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

18. Process Timeline – Baseline
In process
Due Date
Corrections Closed
2006
2007
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Inbound Data
Processing
Outbound Data
Validation/Confirmation
Aggregation/Scoring
Plan Data History
Re-Scoring/Computing
Rewards Paid
Hospital Feedback/Benchmarks
Plans & Purchasers
Program Reporting
Other Events
JCAHO Core Measures
Efficiency – ALOS & Readmit
LFG Survey Results
3Q05
4Q05
3Q-4Q05
’06 3Q 4Q
3Q, 4Q
Initial rewards for top performers at implementer’s option
’06 Program Changes (v1.1)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

19. Process Timeline – Ongoing
In process
Due Date
Corrections Closed
2006
2007
2008
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Jan
Mar
May
Jul
Dec
Feb
Apr
Jun
Inbound Data
Processing
Outbound Data
Validation/Confirmation
Aggregation/Scoring
Plan Data History
Re-Scoring/Computing
Rewards Paid
Hospital Feedback/Benchmarks
Plans & Purchasers
Program Reporting
Other Events
JCAHO Core Measures
Efficiency – ALOS & Readmit
LFG Survey Results
Cycle
Cycle
Cycle
Cycle
Cycle
3Q05
4Q05
1Q06
2Q06
3Q06
4Q06
1Q07
2Q07
3Q07
4Q07
3Q-4Q05
1Q, 2Q06
3Q, 4Q06
1Q, 2Q07
3Q, 4Q07
’06
’06
’07
’07
’08 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
3Q, 4Q
1Q, 2Q
3Q, 4Q
1Q, 2Q
3Q, 4Q
Base period plus two periods improvement or sustained top performance
’07 Program Changes (v2.0)
’08 Program Changes (v3.0)
CMV Contract turnover
CMV Contract turnover
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

20. Addenda
Scoring Details

21. Leapfrog Hospital Rewards Program Scoring Component Measures – Quality
Continuous measures, e.g., % compliance Example: AMI - aspirin at arrival (weight 16.06%)
72.3% compliance x 16.06% = 11.61% contribution to total score
multiple compliance measures within category are further weighted by denominators of each measure
Graded/categorical measures, e.g., LFG partial credit results Example: Pneumonia - Leapfrog Quality Index (weight 12.5%)
Fully implemented = full weight (12.50%)
Good progress = 2/3 of weight (8.33%)
Good early stage effort = 1/3 of weight (4.17%)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

22. Leapfrog Hospital Rewards Program Scoring Component Measures – Quality (cont’d)
Risk-adjusted rates, e.g., % mortality rate Example: Deliveries – 3rd/4th degree lacerations (weight 8.33%) Percent rank (0 – 100%), where 0 = worst, 100 = best, times weight
All or none, e.g., LFG NICU average census Example: NICU average daily census 15+ for hospitals electively admitting high-risk deliveries (weight 23.0%) Yes = 23.0% No (or no NICU) = 0.0%
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

23. Weighting & Scoring – AMI
Measure
Source
Weight
Scoring
Inpatient mortality
JCAHO
(AMI=9)
15.33%
Percent rank (0% = worst, 100% = best) times
15.33% weight
Aspirin at arrival
(AMI-1)
16.06%
% compliance times weight
Beta blocker at arrival
(AMI-5)
14.61%
Aspirin prescribed at discharge
(AMI-2)
4.83%
Beta blocker prescribed at discharge
(AMI-6)
ACEI for LVSD
(AMI-3)
Thrombolytic agent received within 30 minutes of arrival
(AMI-7a)
PCI with door-to-balloon time within 90 minutes of arrival
LFG
Adult smoking cessation advice/ counseling
(AMI-4)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

24. Weighting & Scoring – AMI (cont’d)
Measure
Source
Weight
Scoring
Computerized physician order entry (CPOE)
LFG
8.33%
Fully implemented: Full credit (8.33%)
Good progress: 2/3 credit (5.55%)
Good early stage effort: 1/3 credit (2.78%)
… else no credit
Intensivist ICU staffing (IPS)
Leapfrog Quality Index (NQF Safe Practices)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

25. Weighting & Scoring – CABG
Measure
Source
Weight
Scoring
Mortality
LFG
34.00%
Full credit if
Public risk-adjusted mortality rate better than state median OR
STS risk-adjusted mortality rate better than national average
… else no credit
Volume
12.00%
Volume ≥ 450
Prophylactic antibiotic received within one hour prior to surgical incision
JCAHO
(SIP-1b)
3.50%
% compliance times weight
Prophylactic antibiotic selection for surgical patients
(SIP-2b)
Prophylactic antibiotics discontinued within 24 hours after surgery end time
(SIP-3b)
Process measures:
CABG using internal mammary artery
Aspirin at discharge
Beta blocker within 24 hours after surgery
Beta blockers prescribed at discharge
Lipid-lowering therapy prescribed at discharge
Extubation within 24 hours after surgery
9.25% +
% compliance times weight for two highest compliance rates of up to six measures reported
… else no credit if not measured
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

26. Weighting & Scoring – CABG (cont’d)
Measure
Source
Weight
Scoring
Computerized physician order entry (CPOE)
LFG
8.33%
Fully implemented: Full credit (8.33%)
Good progress: 2/3 credit (5.55%)
Good early stage effort: 1/3 credit (2.78%)
… else no credit
Intensivist ICU staffing (IPS)
Leapfrog Quality Index (NQF Safe Practices)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

27. Weighting & Scoring – PCI
Measure
Source
Weight
Scoring
Mortality
LFG
34.00%
Full credit if
Public risk-adjusted mortality rate better than state median OR
ACC risk-adjusted mortality rate better than national average
… else no credit
Volume
12.00%
Volume ≥ 400
Process measures:
Aspirin at arrival
1st balloon inflation within 90 minutes
14.50% 14.50%
% compliance times weight for each measure
… else no credit if not measured
Computerized physician order entry (CPOE)
8.33%
Fully implemented: Full credit (8.33%)
Good progress: 2/3 credit (5.55%)
Good early stage effort: 1/3 credit (2.78%)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

28. Weighting & Scoring – PCI (cont’d)
Measure
Source
Weight
Scoring
Intensivist ICU staffing (IPS)
LFG
8.33%
Fully implemented: Full credit (8.33%)
Good progress: 2/3 credit (5.55%)
Good early stage effort: 1/3 credit (2.78%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

29. Weighting & Scoring – Pneumonia
Measure
Source
Weight
Scoring
Initial antibiotic received within 4 hours of hospital arrival
JCAHO
(PN-5b)
5.50%
Percent rank (0% = worst, 100% = best) times
5.50% weight
Influenza vaccination
(PN-7)
7.50%
% compliance times weight
Pneumococcal vaccination
(PN-2)
12.00%
Adult smoking cessation advice/ counseling
(PN-4)
Intensivist ICU staffing (IPS)
LFG
13.50%
Fully implemented: Full credit (13.50%)
Good progress: 2/3 credit (9.00%)
Good early stage effort: 1/3 credit (4.50%)
… else no credit
Oxygenation assessment
(PN-1)
14.50%
Blood cultures (collected prior to antibiotic administration)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

30. Weighting & Scoring – Pneumonia (cont’d)
Measure
Source
Weight
Scoring
Computerized physician order entry (CPOE)
LFG
12.50%
Fully implemented: Full credit (12.50%)
Good progress: 2/3 credit (8.33%)
Good early stage effort: 1/3 credit (4.17%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006

31. Weighting & Scoring – Deliveries
Measure
Source
Weight*
Scoring
Inpatient neonatal mortality
JCAHO
(PR-2)
23.00% or 60.50%
Percent rank (0% = worst, 100% = best) times
23.00% or 60.50% weight
NICU census *
LFG
23.00% or 0.00%
Full credit if
NICU census ≥ 15
… else no credit
Antenatal steroids for certain high-risk deliveries *
29.00% or 0.00%
% compliance times weight (if measure is applicable)
Third- or fourth-degree lacerations
(PR-3)
8.33% or 13.17%
8.33% or 13.17% weight
Computerized physician order entry (CPOE)
Fully implemented: Full credit (8.33% or 13.17% )
Good progress: 2/3 credit (5.55% or 13.17% )
Good early stage effort: 1/3 credit (2.78% or 13.17% )
Leapfrog Quality Index (NQF Safe Practices)
Fully implemented: Full credit (8.33%)
Good progress: 2/3 credit (5.55%)
Good early stage effort: 1/3 credit (2.78%)
* For a hospital indicating in its Leapfrog survey responses that it electively admits high-risk deliveries (mothers expected to deliver complicated newborns), NICU census and Antenatal steroids measures do not apply. The weights associated with these measures are allocated to the remaining measures and the second set of weights applies.
Leapfrog Hospital Rewards Program: Data Reporting and Scoring
2/06/2006